Mountain Medicine: Health Care in the 1800’s.  In the early 1800’s it was generally believed that illness and disease were caused by an accumulation of “poisons” in the body, and that if these poisons could be eliminated, the patient would recover their health.  There were three main therapeutic principles for treatment of disease: bleeding by opening a vein or use of leaches, purging the gastrointestinal system with laxatives, emetics (agents which cause vomiting) and enemas; and sweating or blistering.  Gastric and intestinal disorders were an everyday occurrence in these times because of poor sanitation, and poor food handling practices. 

People who lived in the 18^th and early 19^th Centuries were largely helpless in the matter of health.  They lived in constant dread of sudden death from disease, plague, epidemic, pneumonia, or accident.  Their letters always began and usually ended with assurances of the good health of the letter writer, a query about the health of the recipient and a wish for continuing good health.  Most doctors during this period learned their trade through the apprentice system in which young men of about 15 years of age lived and trained with established physicians.  The arrangement would last for anywhere from two to six years.  A few students might continue on to a formal education in a medical school for another two to four years.  However, most physicians at the beginning of 1800’s opened their practices without the benefits of a degree. 

State licensing of physicians was required only sporadically during the 1800’s, and medical practices were never inspected.  Quacks and charlatans practiced virtually unchecked.  Additionally it was difficult to determine what was a quack treatment from what was useful, because even legitimate treatments were often based on ignorant notions and hunches to begin with, and frequently did more harm than good.  Distrust of physicians ran high during these times, and often those afflicted with illness would attempt their own treatments through folk medicine before resorting to “professional care.”  Thomas Jefferson wrote “I believe we may safely affirm that the inexperienced and presumptuous band of medical tyros (tyrants) let loose upon the world, destroys more of human life in one year, than all the Robinhoods, Cartouches, and Macbeaths do in a century.”  The Mountain Men may have had more successful recoveries from some illnesses, precisely because they lacked access to "professional" medical care. 

The faintest glimmers of modern medicine were beginning in the early 1800’s.  By 1800 it was generally known that exposure to the puss from cow-pox would prevent small pox and Thomas Jefferson, his family and Meriwether Lewis were inoculated.  However, the men of the Lewis & Clark expedition were not protected by vaccination against this disease.  In 1832, the U.S. Government would send two doctors to vaccinate all of the Indians along the Missouri River.  Perhaps as many as half of the Indians the two doctors met accepted vaccinations, and maybe several thousand total were vaccinated during the course of the season. 

The Mountain Men would likely have experienced all manner of wounds and lacerations, from mishaps with tomahawks and knives, to gunshot and arrow wounds.  Gastric and intestinal disorders would have been a common occurrence due to poor food handling, and the propensity to eat whatever was available during lean times, no matter how "ripe".  Venereal diseases were passed between the mountain men and the Indian tribes with which they associated.  These included syphilis, gonorrhea and possibly chlamydia.  Outbreaks of Malaria and Yellow Fever would have impacted the Mountain Men.  They would also have been susceptible to Small Pox, though with out the widespread devastation wreaked by this disease on populations of native peoples.  Cholera, which periodically swept up the Missouri River was a disease deadly to all and could be fatal within two hours of the onset of symptoms.  Hypothermia may have been a common affliction because of the requirement to wade waist deep in freezing streams to set traps.  Winter travel always came with the risk of frostbite.  Temperatures as low as -44 degrees Fahrenheit were recorded on the plains by Lewis & Clark in the winter of 1803-1804.  Professional medical attention for injuries or illness was only available in the wilderness at extremely rare intervals.  When illness or injury struck, most trappers were reliant on folk medicine known to themselves or their companions, or Indian remedies. 

An extensive inventory of medicines and medical supplies taken along on the Lewis and Clark expedition is available.  This being a military expedition, the officers were responsible for the health of their men and so considerable thought and effort was given to health care and medicines.  A doctor did not accompany the expedition, although Lewis did receive brief training from Dr Benjamin Rush in Philadelphia prior to departing.  In practice, Clark more often acted as the physician, especially in treating ailments of the Indians, perhaps because he had a more soothing manner.  Treating Indian ailments aided in the success of the return trip to St. Louis.  At this time most of the Corps. trade goods were depleted, however, Clark was able to trade medical services for food, and horses at critical times on the return trip. 

Indian Medicine:  The Indian term for medicine, in many tribes was synonymous with mystery.  Through trial and error, certain herbs and remedies were found to be effective, however, how the cure was effected was not understood and hence medicine.  Although not true for all, many tribes had two levels of physicians, the herbalist or apothecary who could treat every day injuries and illness, and the “Medicine Man” or Shaman, part doctor, part religious leader who treated serious or life threatening illness.  The Medicine Man might or might not use the same remedies as used by the herbalist, but through the use of chants, charms, dances and ceremonies was able to impart greater power to the remedy.

Indian treatments for externally caused injuries such as fractures, dislocations, insect and snake bites, arrow and bullet wounds were rational and often very effective.  Although practices were not consistent, or known to all tribes, some Indians did know that certain herbs would aid in the healing of wounds (antiseptics), knew how to remove embedded arrows or bullets, practiced contraception through use of ingested herbs, and develop use of syringes for irrigating wounds and for placement of herbal treatments.  Indians were also familiar with the use of herbal laxatives and emetics for treating gastro-intestinal illnesses. 

In the case of persistent internal diseases which did not respond readily to medicine, the illness might be attributed to supernatural causes such as malevolent spirits.  If the spirit could be induced to leave the body, the illness would be cured.   Indian disease theory was in many ways was similar to disease theory of white medical professionals of the early 1800s.  Substitute poison for spirit and compare to 1800’s white disease theory described above, although the shamanistic cures were less injurious to the body then the white medical practioner’s cures.   Indian remedies were often rejected out of hand by white medical professionals and the clergy of the time.  However, at the frontier and into the wilderness, where physicians were absent, or rare, many whites embraced these remedies.  French voyageurs and coureurs du bois preferred the Indian treatments for wounds and chronic sores with poultices and herbs to the treatments of white doctors.  Indian hygiene was superior to that practiced by whites at the time.  Indians bathed frequently, often daily, even the northern tribes, and throughout the year.  The average life expectancy of Indians (prior to the introduction of tuberculosis, small pox, typhoid, measles, venereal diseases, and other European diseases) based on skeletal evidence was 37 years, plus or minus three years, as compared to 35 years for white Americans in the late 1700’s. 

Glossary of Treatments, Medicines, Diseases and Terminology

Ague:  A term used to describe the fevers and chills resulting from malaria.  

Alum, crystalline potassium aluminum sulfate,  was used medicinally as a topical astringent, that is a compound which caused the bodies tissues to draw together or constrict.  It was effective in slowing the flow of blood or other bodily fluids.  Alum is amongst trade items listed as brought to rendezvous.  

Amputation was a common method for treating severe injuries to the limbs.  Tom Smith while part of a brigade of fur trappers led by Sylvester Pratte in North Park (Colorado) was shot by an Indian.  The bullet had struck his left leg above the ankle and shattered the bones.  While it was clear that the lower part of the leg would have to be amputated, none of the men in the brigade were willing to do so.  Finally Smith called for a butcher knife and started to amputate his own foot.  Finally Milton Sublette finished the operation for Smith.  However, Smith was not expected to live, because he refused cauterization.  He did live and heal, and before he returned from the mountains, had whittled himself a wooden leg, and was thereafter known as Tom “Peg Leg” Smith. 

Anesthetics:  Prior to the 1840s patients would sing hymns, bit a bullet, get drunk, or take opium to distract themselves from the horrific pains of surgery.  It is reported that amputations at this time were often done in as little as 40 seconds, and even seasoned surgeons were repulsed by the agony involved.  It wasn’t until the 1840’s that nitrous oxide (laughing gas), ether and chloroform were introduced.  Even then these anesthetics would not have been available for emergency treatments in the wilderness. 

Bathing:  was not practiced with any regularity by the mountain men.  In fact during the first half of the 1800’s, due to a lack of indoor plumbing and the time and effort required to heat water, few Americans, even in the cities, bathed with any regularity.  There was also a belief at this time that baths in the winter caused colds and other illnesses.   Consequently, many Americans bathed as little as once a year.  As plumbing systems in the cities improved, the frequency of bathing increased to as much as once a week.  The Grahamites (followers of a particular health movement) went so far as to bathe three times a week, a practice many condemned as “unnatural.”

Bleeding or Bloodletting,  a process of draining a patient’s blood either by lancing the flesh, or by applying live leaches.  The process was thought to relieve tension on constricted arteries and to allow “poisons” to drain from the body, thereby curing any underlying disease.  Bloodletting was a widely used therapy during the first half of the 1800’s , with a few diehard proponents continuing the practice as late as the 1870s.  Medical Guru Benjamin Rush recommended bleeding patients as much as one pint or more per day.  In reality, this treatment lowered blood pressure, weakened patients, and did nothing to remedy any illness.  In contrast, for purposes of donating blood today, a donor is allowed to give only one pint of blood no more frequently than once every 56 days.  Some Indians practiced bleeding, however, more for symbolic purposes, never to the extreme of causing fainting. 

Blistering the skin by use of either a hot iron, or by caustic chemicals.  This was another treatment designed to allow “poisons” to drain from the body, but through the clear fluids discharged from the burned area.  This was another ineffective treatment, often used for infections, advocated by Medical Guru Benjamin Rush.

Calomel was one of the most widely prescribed drugs during the first half of the 1800’s, and was amongst the medicinal supplies taken with the Lewis and Clark expedition.  Calomel is mercurous chloride, in the form of a white insoluble powder, which is now used as a fungicide.  The medicinal effect of this compound is as a very powerful laxative, again advocated by Medical Guru Benjamin Rush, as a means to relax the interior of the body and expel disease causing “poisons”.  Use of this highly toxic mercury compound could cause serious damage to the nervous system, destroy the patient’s teeth and gums, while doing nothing to cure any disease. 

Castoreum (Castor):  An oily substance with a strong smell secreted by beaver.  Castor is credited with all sorts of medicinal properties.  A salve of castor and beaver oil was used by Osborne Russell to treat arrow wounds received in an attack by Blackfoot Indians.  Russell states that use of this salve eased the pain and drew out the swelling in a great measure. 

Castor Oil:  A vegetable oil extracted from the seed of the castor plant, it is used medicinally as a laxative. 

Catarrh was the term applied to any inflammation of the mucous membranes, especially in the nose and throat.

Cholera:  Cholera was a serious disease in North America in the 1800’s, with major epidemics in 1832, 1849, 1866, and 1873.  The disease is spread by unsanitary conditions.  Cholera causes diarrhea and dehydration, and can  be fatal in just hours.  One of the contributing factors in the decision to abandon Bent’s Fort may have been an outbreak of cholera in the area.  In 1835 a supply train for the Rendezvous in 1835 was struck with an outbreak of cholera.  Dr. Marcus Whitman, a missionary to the Indians traveling with this train is reported to have treated the victims even though he was himself ill.  For a description of the 1832 epidemic click here.  

Consumption:  This is the common name given to the lung destroying disease, tuberculosis.  Dr. Benjamin Rush thought the disease could be caused by tobacco smoking, and could be cured by vigorous horseback riding, opium, or a meat diet, along with his bleeding and purging remedies. 

Copaiba:  An aromatic resin obtained from South American trees of the pea family and formerly used as a medicine for chronic inflammations of the mucous membranes (catarrh)

Dyspepsia (Bilious Attack):  Indigestion.

Flux, or Bloody Flux, probably dysentery caused by drinking polluted water.  Dysentery is a painful bacterial or protozoan disease, characterized by inflammation of the intestine accompanied by diarrhea with frequent discharge of blood and mucus. 

Frost Bite: occurs when ice crystals form in body tissues, generally the extremities after exposure to freezing temperatures.  The frost bit parts could sometimes be saved by gradual warming, though in most case the frost bit extremity had to be removed by amputation.   

Glauber Salts are a sulfate of soda, and was used as a cathartic, or strong laxative.  Glauber Salts occur naturally in some mineral springs, and in many salt deposits.  Glauber Salts were amongst supplies listed as rendezvous trade items. 

Gunpowder was used as a remedy for rattlesnake bite.  The wound was creased immediately above and below.  A small portion of gunpowder was sprinkled over the wound and burnt four or five times in succession, thus supposedly completely destroying the effects of the poison. 

Head Lice:  Head lice were a common affliction for all people in the 1800's due to poor hygiene and infrequent bathing.  The treatment for head lice was to soak the hair in kerosene oil two-three times a day, and to keep the head wrapped in a cloth for twenty-four hours.  After the treatment was completed it was recommended that the hair should be washed. 

Hypothermia (Exposure) results from overall cooling of the body, with a loss of core temperature.  Hypothermia does not require cold temperatures, and is often deadly, even in the summer.  Death can occur in as little as 15-20 minutes if the body is exposed to cold water, or is placed in a situation of rapid heat loss.  Hypothermia must have been a common occupational hazard of the mountain men, as their business required them to wade, often waist deep, in icy mountain streams and ponds to set traps.  To minimize the risks of hypothermia, Mountain Men often worked in pairs, the first man wading into the water to set the traps, the second man to watch the equipment, horses, and most importantly to start a fire for the first man to warm up and dry off after he had set the traps. 

Laudanum:  A solution of 10% opium in alcohol and water.  This medication was used for pain relief.  Use of this medicine often resulted in addiction. 

Malaria (Autumnal Disease):  A disease spread by mosquitoes which caused severe fevers, chills and weakness.  Outbreaks of this disease were common throughout the south and west in the 1800’s.  Victims of the disease suffered from these symptoms periodically for the remainder of their lives, and were also more susceptible to other potentially deadly diseases.  Mosquitoes were not recognized as the source of the disease, although at the time Lewis and Clark set out on their expedition Dr Benjamin Rush believed that poisonous fumes rising from swamps was the cause. 

Measles:  Now a childhood disease, easily controlled through vaccinations, measles through the 1800’s could be deadly, especially to Indians of all ages who had never been exposed to this disease.  An outbreak of this disease among the Cayuse Indians, in which as many as half of the tribe may have died,  was a contributing factor in the Whitman Massacre.  The Cayuse noted that while the disease was deadly to them, the Whites of the mission were not being notably impacted.   From this the Cayuse concluded that they were being poisoned for their land. 

Opium: was used to help control mild pain through much of the 1800’s.  It was sold over the counter in drug stores in the form of a pill, or as Laudanum. 

Jalap:  A yellow sweet powder made from the dried roots of a Mexican vine of the Morning Glory family, used as a laxative to relax the interior of the body and expel disease causing poisons. 

Peruvian Bark (Cinchona):  Peruvian Bark, containing quinine, was one of the truly effective medicines, used primarily for malarial and other types of fevers.  Lewis and Clark took the equivalent of 3,000 doses of Peruvian Bark on their expedition. 

Puking:  A treatment involving dosing a patient with emetics to produce vomiting, another method for expelling disease causing “poisons” from the body.  

Purging:  A treatment involving dosing a patient with powerful laxatives to relax the interior of the body, to expel disease causing “poisons” from the body. 

Rush, Dr. Benjamin:  He was a professor at the Institutes of Medicine at the University of Pennsylvania starting in 1791.  As a professor and physician, he was hugely influential in the practice of medicine, especially in advocating bleeding, blistering, sweating, puking and purging therapies.  The basic premise of these treatments was that diseases were caused by “poisons” within the body, and if these “poisons” could be expelled, the disease could be cured.  Dr. Rush was a contemporary of Thomas Jefferson and Meriwether Lewis.  Lewis consulted closely with Dr. Rush regarding medical supplies to be taken on the expedition.  Dr Rush’s influence can be clearly seen in the list of supplies, including fifty dozen “Rush’s Pills” (Thunderbolts) taken by the expedition. 

Rush’s Thunderbolts:  A mixture of very potent laxatives in pill form concocted by Dr. Rush.  It is said that the effects of ingesting a single “Thunderbolt” were immediate and violent. 

Scurvy:  A disease that develops after about one-hundred days on a diet lacking vitamin C.  Symptoms include extreme sensitivity to touch throughout the entire body, purple spots, stiffness in the legs and thighs, loosening or loss of teeth, and loss of vigor.  Although some Indian tribes are known to have suffered from scurvy, it is doubtful that Mountain Men were afflicted with this disease.  A three ounce serving of buffalo meat contains about nine percent of the recommended daily requirement of vitamin C.  Buffalo was one of the preferred foods of the Mountain Men, who would eat as much as 12 pounds of meat a day when available.   

Small Pox is a disease caused by a virus and transmitted from person to person through the air.  Once infected, symptoms would appear in 10-12 days.  The person would develop aches and a high fever.  Two to four days later a rash appeared on the face and spread to other parts of the body.  The rash resembled thousands of small pimples which over the next week would grow in size and fill with puss.  Scabs formed over the pimples and would fall off, leaving deep scars on any survivors.  There was no treatment for the disease which would kill over twenty percent of its victims.  Indians, who had never been exposed to the disease before, were even more susceptible to its ravages.   Outbreaks of the disease along the Upper Missouri tended to be limited to small areas because transmission required person to person contact.  During the winter season travel between Indian groups was severely restricted and as a result outbreaks of the disease tended to die out.  With the coming of the steamship to the Upper Missouri, it became possible for a single, infected individual to transmit the disease to both Indians and whites along hundreds of miles of the river.  The single worst outbreak of this disease utilized the S.S. St. Peter's as a transmission vector.  For more information about this outbreak click here. 

Surgery was performed without anesthesia before the 1840’s and without antiseptics before the 1880’s.  Dr. Marcus Whitman performed surgery on Jim Bridger at the Rendezvous of 1835, to remove a Blackfoot arrowhead which had been lodged in Bridger’s hip since an attack in 1832.  The surgery was difficult, because the arrowhead was hooked at the point, and a cartilaginous substance had grown around it in the years that it was lodged in Bridger’s body.  The surgery was performed without anesthetics.  Samuel Parker, a missionary traveling with Whitman records;  “The Doctor pursued the operation with great self-possession and perseverance;  and his patient manifested equal firmness.” 

Sweating:  A treatment by which patients were made to “sweat” out disease causing “poisons”.  

White Vitriol is a crystalline salt, ZnSO₄.  It was used medicinally as a weak antiseptic, and emetic and as an astringent, that is a compound which caused the bodies tissues to draw together or constrict.  It was effective in slowing the flow of blood or other bodily fluids.

Yellow Fever (Black Vomit): A disease spread by mosquitoes, it attacked the liver and kidneys.  The characteristic symptom of the disease was jaundiced or yellow appearance of the skin. 

To learn more about health care and medicine in the 1800’s see the following references:

The Writer’s Guide to Everyday Life in the 1800’s, by Marc McCutcheon, published by Writer’s Digest Books, 1993.  The health, medicine and hygiene chapter gives a brief description of common maladies, and diseases of the 1800’s as well as typical treatments, and the philosophy behind the treatments of the day. 

Lewis & Clark: Doctors in the Wilderness, by Bruce C. Patton, published by Fulcrum Publishing, Golden Colorado, 2001.  An excellent description of disease theory, medical practice, and an analysis of the various illnesses and maladies, and remedies, as described in the journals of Lewis & Clark. 

American Indian Medicine, by Virgil J Vogel, published by University of Oklahoma Press, 1970.  A complete description of Indian disease theory, remedies, and the effect of Indian medicinal practices on white civilization. 

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